How to prevent Military Drill Sergeants from making the unethical Research Paper

How to prevent Military Drill Sergeants from making the unethical decision to Fraternize with Trainees - Research Paper Example eant who is an expert in the warrior duties and the in the battle drills is expected to live the values of the army by showing the warrior ethos which is the epitome of the army profession (Long, 2008). A military drill sergeant is expected to be responsible for coaching, providing counseling and giving mentorship to too many thousands of soldiers as he or she changes them from being a civilian to a ready soldier. A military drill sergeant starts his work before dawn and his with the soldiers throughout the day. Being a military drill sergeant, the soldiers’ looks up to you as the only person they know in the army. The soldiers always try to copy you in everything you do. Being a military drill sergeant is very difficult. The job is very demanding and can be attributed to the several tasks that are to be fulfilled. Just the same, way you will remember your military drill sergeant is the same way your soldiers will. It is for this reason that it is your duty to make sure you give a positive and a rewarding experience to the soldiers who are starting their journey in the army. Everything you do to the soldiers will affect them throughout their lives (Baker, 2008). There are different reasons that are attached to mistreatment of trainees by the military drill sergeants. The main reason why this happens is the notion since they were also mistreated they will have to do the same to others. It is a sort of revenge that the drill sergeants undertake. At other times, the chain is usually commanding from the highest order to the lowest order. The people in the higher ranks mistreat those who are under them. This continues in a chain until the lowest order where the military drill sergeants mistreat the trainees and their property. Gender also leads to mistreatment of some trainees. Male military drill sergeants feel that they should use the female trainees for their personal desires. This in most cases leads to cases of rape that become hard to handle. In addition,

A Systems Approach to Planning, Scheduling, and Controlling in Corwin Outline

A Systems Approach to Planning, Scheduling, and Controlling in Corwin Corporation - Outline Example 8. Lack of team unity: The supervisors demonstrated weak leadership by abandoning members of their team and engaged in a blame-game which led to conflict amongst the team, thereby negatively affecting project outcomes.8. Lack of team unity: The supervisors demonstrated weak leadership by abandoning members of their team and engaged in a blame-game which led to conflict amongst the team, thereby negatively affecting project outcomes.9. Unskilled employees: The lack of skilled participants for the project jeopardized the quality of decisions made (in this case the faulty decision of accepting the project by violating cost margins in support of the client).2. Poor external communication: Internal stakeholders were not taken into confidence along with no clear guidelines as to who has authority for the project led to conflicts, confusion and lack of unanimous direction.3. Weaknesses in corporate culture: As per Corwin’s culture, employees did not feel the need to alert their super iors in case of critical data which led to ignorance of underlying problems and ultimate failure.1. Delayed engagement of line managers in the process: Corwin’s line managers were unable to provide their inputs during the proposal that could have influenced it and could have given a clearer picture beforehand.2. Poor procurement decision: Corwin’s decision to procure raw materials before the contract was signed which exposed the company to financial risk in case anything went wrong prior to the contract signing.3. Poorly planned change management process: Testing process was continuously altered which led to inconsistent results and increased costs for Corwin.

Celebrity Endorser Influence Essay Example for Free

Celebrity Endorser Influence Essay Celebrity Endorser Influence on Attitude Toward Advertisements and Brands Bahram Ranjbarian Associate Professor of management, Department of Management The University of Isfahan, Isfahan, Iran E-mail: Bahram1 [emailprotected] Zahra Shekarchizade Master Student of Business Management, Department of Management University of Isfahan, Isfahan, Iran E-mail: [emailprotected] Zahra Momeni Master Student of Business Management, Department of Management University of Isfahan, Isfahan, Iran E-mail: [emailprotected] Abstract Purpose- This study aims to analyze the celebrity endorser influence on attitude toward advertisements and brands. Design/methodology/approach – A theoretical model is developed and tested with a sample of 193 students in University of Isfahan in 2009. Structural equation modeling was used with LISREL 8.50 and the maximum likelihood (ML) method. Findings – The findings show that attitude toward celebrity endorser can influence on attitude toward brand directly or indirectly. In indirectly approach, attitude toward advertisement is as a mediator between attitude toward celebrity endorser and attitude toward brand. On the other hand, attitude toward celebrity endorser has not significant effect on purchase intention. Originality/value – This paper provides a model connecting attitude toward celebrity endorser, attitude toward advertisement and attitude toward brand that has been examined and validated using a sample of students in University of Isfahan. Paper type- Research paper Keywords: Endorsement, Celebrities, Brand, Attitude, Advertisement Introduction Today one of the most prevalent forms of retail advertising is through using of celebrity endorsement (White et al, 2007). In fact celebrity endorsers are being used in about 25 percent of all television advertisements in order to promote brands (Erdogan et al, 2001).These endorsers are being paid by about 10 percent of advertisers budgets (Agrawal and Kamakura, 1995). Marketers invest huge amounts of money in contracts with celebrity endorsers each year, since they believe that celebrities affect the process of selling of their brands or products (Katyal, 2007). A celebrity endorser is a wellknown person (e.g., actors, sports figures and artists) because of his successes in a special field other than the endorsed product class (James, 2004). Celebrity endorsers are used by firms who want to 399 European Journal of Social Sciences – Volume 13, Number 3 (2010) support a product or service (Amos et al, 2008). Since presence of celebrity endorsers affects purchase decisions of consumers positively, producers and retailers have always preferred to use celebrity endorsements in order to sell their products (Stafford et al, 2003; Erdogan, 1999; Kamins, 1990). Kaikati (1987) believes that using of celebrities in advertisements could have many benefits and advantages including: 1) facilitating of brand identification 2) changing or impressing the negative attitude towards a brand 3) repositioning an existing brand 4) global marketing or positioning of a brand or product 5) affecting purchase intentions of consumers. Although using of celebrity endorsers as brand messengers is impressive, but it could have some risks. For instance, celebrities who are known to be guilty because of negative events (e.g., accident) may have harmful effects on the products that they endorse (Lou ie and Obermiller, 2002). Studies reveal that using of attractive celebrity causes to increase attitude towards advertisements. Such attitude towards advertisements is defined as mental states which are used by individuals to organize the way they perceive their environment and control the way they respond to it (Haghirian, 2004). There is a considerable correlation between desirable attitudes with regard to advertising and rating of certain advertisements by respondents as being likeable, irritating, delightful, etc (Bauer and Greyser, 1968). Celebrity endorsers enhance awareness of a companys advertising, create positive feelings towards brands and are perceived by consumers as more amusing (Solomon, 2002). Thus using of a celebrity in advertising causes to influence brand attitude and purchase intentions of consumers in a positive way. Celebrity endorsement has a strong effect on consumers memory and learning approach too. Most consumers are not in a purchasing situation when they are encounter with message of the brand. Marketers use celebrity endorsement in order to help better storage of information in consumers minds which they can easily remember in purchasing situations (Schultz and Brens, 1995). However, there are many studies about celebrity endorser, but it seems that there are limited researches about the relationship between celebrity endorser and attitudes. The purpose of this study is to specify the impact of using celebrity endorsers in Iranian advertisements on attitudes of students in University of Isfahan toward those ads and brands. Literature Review Some properties such as likeability, expertise, trustworthiness and similarity cause a celebrity endorser to become a source of persuasive information and this creates a sense of certainty which has been revealed in many studies (Suranaa, 2008). Also physical attractiveness of the endorser is considerable in effectiveness of a message (Khatri, 2006). Acceptance of a message by a receiver could be influenced by celebrity endorsers as believable sources of information about a product or a firm (Amos et al, 2008). Using of celebrity endorsers to support products is explained by balance theory principles too. According to this theory, successful companies establish an emotional relation between the observer and endorser and a relation between endorser and brand too (Mowen, 2000). Before proceeding conceptual model, we describe the main constructs of this study. Celebrity Endorser McCracken (1998) has defined celebrity endorser as any individual who enjoys public cognition and who uses this cognition on behalf of a consumer by appearing wit in an advertisement. Moreover, celebrity is used as testimonial, endorsement, actor or spokesperson by the firm. Research has demonstrated that celebrity endorsement affects consumers feelings in general and it could affect the attitude of consumers towards the advertisement and brands too. This could result in enhancing of purchase intentions and as a result enhancing of sales. Some properties like credibility, physical attractiveness and likeability of celebrity endorser influence the ability of one person to impact other person (Amos et al, 2008). Source credibility is referred to identifying of communicators positive properties which influences acceptance of a message by the receiver (Ohanian, 1990). This consists of two main dimensions of expertise and 400 European Journal of Social Sciences – Volume 13, Number 3 (2010) trustworthiness. Source expertise refers to the degree which a communicator is perceived to be a source of valid assertion (Roozen, 2008). Source trustworthiness refers to faithfulness and reliability of the spokesperson (Khatri, 2006). Source attractiveness is the personality, likeability and similarity of endorsers to the receiver, thus to the perceived social values of the source (Solomon, 2002). Physical attractiveness of the source include being attractive, beautiful, elegant and charming. According to the studies in this ground, expertise dimension is more significant than physical attractiveness for matching of a brand with a suitable endorser (Brian and Michael, 1998). Likeability is referred to the positive or negative feelings that consumers have towards a source of information. We can define likeability as affection for the source because of its physical appearance and behavior (Erdogan, 1999). Though some research results reveal effectiveness of celebrities as endorsers (Freiden, 1984), but other researches suggest that celebrity endorsement may have different degrees of effectiveness depending on other factors like the fit between the celebrity and the advertised product (Till and Shimp, 1998). Celebrity Endorsers Effect on Aad and Ao Marketers are especially interested in consumers attitudes towards advertisements and brands. Essentially, attitudes are our predispositions with regard to things. An attitude shows whether we like something or not. Attitudes have three basic components: affective, cognitive and behavioral. Affective is related to our liking or feelings about an object. Cognitive is referred to beliefs about an object and behavioral component regards actions we take about that object (Severin and Tankard, 2001). Attitude towards advertisement is defined as a learned tendency to respond in a consistently desirable or undesirable approach toward advertising in general (Haghirian, 2004). On the other side, attitude towards the advertisement (Aad) is whether the consumer likes an advertisement (Ad) or hates it. Determinants of Aad consist of attitude towards the advertiser, assessment of the Ad execution itself, the mood evoked by Ad, and the extent to which the Ad affect viewers encouragement. Assessment of brands could be influenced by attitudes towards Ads. Of course what causes an advertisement to be impressive will change noticeably cross-culturally (Arnold et al, 2004). In performed studies, Aad is focused on as a mediator of advertisers effects on brand attitudes and purchase intentions (Suhere and Ispir, 2009). In recent studies, this issue has been proved that using of celebrity endorsement has a positive impact on attitudes of the consumer towards products and brands with which they are associated brand (Seno and Lukas, 2005). Agarwal and Malhotra (2005) have defined brand attitude as consumers general evaluative judgment of a brand based on brand beliefs. Such beliefs concern product-related attributes, like practical and experimental benefits. A successful endorser is able to enhance intentions and preferences towards brands directly or indirectly. An endorser who has major source factors of credibility (like expertise, trustworthiness and effectiveness) is able to impress purchase intentions of the consumer considerably (Liu et al, 2007). Information from a credible source can impress ideas, attitudes and behavior through a process called internalization (Belch and Belch, 1993). Internalization occurs when the receiver is motivated to have an issue. The receiver learns and accepts the idea of the credible spokesperson, since he supposes that information of this person represents an accurate position on the issue. Therefore, if such spokesperson who is known to be an expert endorses a product, consumers will more probably have a desirable idea about that advertisement and brand and they will consider it in their shopping list the next time they go shopping. Researchers have used the identification process of social influence in order to explain the effectiveness of celebrity endorsers (Basil, 1996). This theory suggests that if an individual identifies with another individual, then he is more likely to accept an attitude or behavior of that individual or a group. The internalization process of social influence is occurred when an individual accepts influence because the induced behavior is congruent with his value system†. An individual accepts the influence, since it provides a solution to a problem (Daneshvary and Schwer, 2000). In the elaboration likelihood model (ELM), individuals level of motivation to process central message arguments is represented which is one of its key factors that affects the relative impact of 401 European Journal of Social Sciences – Volume 13, Number 3 (2010) central and peripheral processing (Petty and Cacioppo, 1986). When applied to an adverting context, ELM suggests that consumers motivation to centrally process brand-relevant aspects of an advertisement is enhanced, the impact of central processing on brand attitudes should be enhanced, the effect of peripheral processing on brand attitudes should be reduced and the effect of brand attitudes on purchase intentions should be enhanced (Lafferty and Goldsmith, 1999). In this theoretical model, the endorser serves as cue just during peripheral processing. Therefore, the effect of the endorser should be reduced while central processing is enhanced. Mackenzie and Lutz (1989) have stated that advertiser credibility is a central processing cue more than any other thing. Credibility of the source is considered important in influence acceptance. A consumer will accept the accurate influence (information) and apply it if t here the source is perceived to be credible. It is accepted because it is demand by ones own values. Therefore, a products endorsement by a credible source may impress purchase behavior (Danwshvary and Schwer, 2000). As a result, celebrity endorsement can increase the process of recalling and consume assessment of products (Khatri, 2006). On the other hand, celebrity endorsement has a severe effect on learning approach and memory. Researchers in the field of marketing and social psychology have studied the manner of impressing of purchase decision by celebrity endorsements. Various hypotheses have been proposed including having recall of the product by celebrity endorsement, celebrities have credibility on expertise that makes the product more desirable or increases perceptions of quality; the celebrity endorsers image is transferred to the product so that those who use the product are associated with the image. Experiments suggest that celebrity endorsement can increase recall and consume assessment of the products in certain situations (Clark and Horstman, 2003). Most of the times, making connection with the brand message is occurred when consumers are not in a purchasing situation. Marketers use celebrity endorsement so that information will be kept in consumers minds better and in the case of purchasing situation, they can easily retrieve it (Surana, 2008). A successful endorser strategy can enhance the level of consumers recalling towards product information, reinforces consumers recognition to endorsed brands, positively influences consumers attitude to low-involved products and even enhance consumers purchase intention and preference towards brands (Liu et al, 2007) Therefore, hypothesizes of the study are as follows. H1: Attitude toward ad is positively affected by attitude toward celebrity endorser. H2: Attitude toward brand is positively affected by attitude toward celebrity endorser H3: Attitude toward brand is positively affected by attitude toward advertisement. H4: Intention to buy is positively affected by attitude toward celebrity endorser Method Data Collection Information was obtained from randomly selected students from University of Isfahan through survey questionnaires during September- November 2009. University of Isfahan is one of the major universities in the fields of science, human science and engineering. A total sample of 193 participants was obtained. The sample was composed of 137 women (71 percent) and 56 men (21 percent). A cluster sampling procedure with age and degree as main control variables was applied. The age of the respondents ranged from 19 to 30 years, with a mean of 24. All questionnaires were self-administered by the participants without interference from researchers. Measures The study uses multi-item scales to measure the constructs in our model. All items in the questionnaire were measured on a five-point Likert-type scale anchored from â€Å"strongly disagree† (1) to â€Å"strongly agree† (5). Some of the measures were available in the literature, though most were adapted to suit this European Journal of Social Sciences – Volume 13, Number 3 (2010) particular context. To measure attitude toward celebrity endorser we used ten items. Attitude toward advertisement and attitude toward brand were measured with six items and five items, respectively. In order to measure reliability of questions in the questionnaire, 30 questionnaires have been pre-tested through pilot studies. Then, amount of confidence coefficient has been calculated by method of Cronbachs alpha for which 0.83 % is obtained. This number shows that the applied questionnaire enjoys confidentiality or in other words the necessary reliability. Results Measurement Model Measurement model Structural equation modeling with LISREL 8.54 and the maximum likelihood (ML) method was used to analyse the data.. LISREL is a structural equations modeling technique that traces structural relations in a set of data (Eriksson et al, 2004). Structural equation modelling was used because it allows to estimate multiple and interrelated dependence relationships and unobserved factors can be represented in these relationships. Additionally, measurement error in the estimation process is accounted for (Hair et al., 1998). The model is assessed with the comparative fit index (CFI), standardised root meanresidual (SRMR), root mean square error of approximation (RMSEA), and Akaike’s (1987) information criterion (AIC). The measurement model provided a good fit to the data: (CFI = 0:98, SRMR=0.058, RMSEA = 0.015 and AIC =396.22). All values of CFI, SRMR, and RMSEA meet the standards suggested by Hu and Bentler (1999): 0.95 for CFI, 0.08 for SRMR, and 0.06 for RMSEA.There are no Guidelines for the AIC but lower values indicate better fit. The fit of the structural model is good and is reported in Table I. In the following we will test our hypotheses and consequently report the standardised path coefficients. As shown in Table I, three of hypotheses are empirically supported and one of them is not confirmed. The effect of attitude toward celebrity endorser on attitude toward advertisement is significant (standardised path coefficient = 0:49). This shows that the higher the attitude toward endorser, the more the attitude toward advertisement. Attitude toward celebrity endorser also have significant effect on attitude toward brand (standardised path coefficient= 0.24), but this effect is comparatively weaker than its effect on attitude toward advertisement. On the other hand, the effect of attitude toward advertisement on attitude toward brand is significant (standardised path coefficient = 0:56). This clearly shows that attitude toward advertisement has the highest standardized path coefficient and therefore has the strongest influence on attitude toward brand. The results show that the effects of attitude celebrity endorser on Purchase intention is not significant (standardised path coefficient = 0.11). This means that attitud toward celebrities, does not necessarily always translates into purchase intentions. Discussion The purpose of this study is to examine the relationship among attitude toward celebrity endorser and attitude toward advertisement and brand. Effects of a celebrity endorser on respondents assessments about advertisements and products endorsed by celebrities have been studied previously. There are some interesting findings for using of celebrity endorsers in Iranian advertisements. Attitude towards a celebrity endorser has a direct positive effect on attitude towards advertisement. Attitude towards advertisement has important effects on attitude towards brands, too and its effect is comparatively stronger than the effect of celebrity endorser. But the effect of attitude toward celebrity endorser on purchase intention is not considerable. Results of this study demonstrate that attitude towards celebrity endorser has an indirect effect on attitude towards brand. This result confirms outcomes of the previous research by Agarwal and Kamakura (1995), Till and Busler (1998), and White et al (2008). When there is a fit between the   European Journal of Social Sciences – Volume 13, Number 3 (2010) endorser and the endorsed product, endorsers image helps construct the image of the brand in consumers minds. In fact, using of an attractive endorser has a positive impact on consumer attitudes towards a brand, because attractive endorsers have a tendency to get more attention than less attractive ones. On the other hand, experience of celebritys negative information can have an undesirable effect on the endorsed product. Transfer of negative information between the celebrity endorser and the endorsed product could be facilitated through cognitive relational pathway. We have considered social position of artists because people have more positive attitude towards artists. So, they distribute attitude towards artists to attitude towards endorsed brand. The association between attitude towards celebrity endorser and attitude towards advertisement has been shown in numerous studies, as the relationship between sports celebrity endorsements and retail products adverting are reported (White et al, 2008) and sports celebrity endorsements are being used in advertisements to impress brand selection. It is recognized in one study that attitude towards advertisement is considered as an interagent that influences attitude towards brand (Suhere and Ispir, 2009). Results of our study reveal that attitude towards advertisement is as an interagent between attitude towards celebrity and attitude towards brand. In our opinion, Iranians are interested in artists and know them as credible sources. So, ads makers use artists as celebrity to impress viewers attitudes towards advertisement and thereupon attitude towards brand. According to previous studies about the effect of the celebrity endorser on purchase intentions, such as Kamins (1990), Ohanian (1991), Liu et al (2007), we expected that positive attitude towards celebrities impressed purchase intentions. But results of this study confirm research outcomes of OMahony and Meenaghan (1997). According to this study, attitude towards celebrities does not necessarily always interpret in to purchase intentions. It seems that Iranians consumer tendency for buying is influenced by other various items such as age, gender, income and education too. Limitation This study has some limitations. The primary limitation of the present research relates to generalizability. The sample was restricted to students in University of Isfahan and this limits our results to be generalized, too. Another relevant consideration is that numerous girl students in university of Isfahan are more than its boy students. Also, this study relied exclusively on questionnaires to assess influence attitude toward celebrity endorser on attitude toward advertisements and brands, whereas this relationships need to be more investigated. On the other hand, this paper could not estimate effect of attitude toward celebrity endorser on purchase intention. In addition, our results are relational and not causal; therefore, it can not be concluded from this study whether attitude toward advertisement and brand is only cause or result of attitude toward celebrity endorser. Conclusion In this study the goal was to indicate the influence of using celebrity endorsers in Iranian advertisements on attitudes of students in University of Isfahan toward those advertisements and brands. The result of this study showed that the positive and significant relationship between attitude toward celebrity endorser and attitude toward advertisements and brands. By analyzing the output resulting from testing hypotheses, it can be concluded that attitude toward celebrity endorser has directly or indirectly influence on attitude toward brand. Consequences suggested that attitude toward advertisement was as a mediator between attitude toward celebrity endorser and attitude toward brand. On the other hand, attitude toward celebrity endorser hadn’t significant influence on purchase intention. So, future researches should put more effort into making strong believable explanations for how celebrity endorsers are able to have significant influence on consumer intention for purchase. References [1] [2] Agrawal, J. and Kamakura, W.A. (1995), â€Å"The economic worth of celebrity endorsers: an event study analysis†, Journal of Marketing, Vol. 59 No. 3, pp. 56-62 Agarwal, J. and Malhotra, N.K. (2005), â€Å"An integrated model of attitude and affect: theoretical foundation and an empirical investigation†, Journal of usiness Research, Vol. 58 No. 4, pp. 483-93. Arnoulds, E., Price, L. and Zinkhan, G. (2004). â€Å"Consumers†. Boston: Mc Graw-Hill. Basil, M.D. (1996), â€Å"Identification as a mediator of celebrity effects†, Journal of Broadcasting Electronic Media, Vol. 40, fall, pp. 478-95. Bauer, R. A. and Greyser, S. A. (1968). â€Å"Advertising in America: The Consumer View†. Boston: Harvard University. Belch, G.E., and Belch, M.A. (1993), â€Å"Introduction to Advertising and Promotion: An Integrated Marketing Communications Perspective†, Irwin, Homewood, IL. Clark, R.C. and Horstman, I.J. (2003), â€Å"Celebrity Endorsents† (www.bu.edu/ e.con/seminar/micro/pdffav) celebendorse.bu.pdf. Clinton, A., Gary, H. and David, S. (2008), â€Å"Exploring the relationship between celebrity endorser effects and advertising effectiveness, a quantitative synthesis of effect size†, International Journal of Advertising, Vol.27 No.2, pp. 209–234. Daneshvary, R. and Schwer R.K. (2000), â€Å"The association endorsement and consumers intention to purchase†, Journal of Consumer Marketing, Vol. 17 No. 3 2000, pp. 203-213. Erdogan, B.Z. (1999), â€Å"Celebrity endorsement: a literature review†, Journal of Marketing Management, 15(3), pp. 291–314. Erdogan, B.Z., Baker, M.J. and Tagg, S. (2001), â€Å"Selecting celebrity endorsers: the practitioner’s perspective†, Journal of Advertising Research, Vol. 41 No. 3, pp. 39-48. Eriksson,K., Kerem,K. and Nilsson,D. (2005), â€Å"Customer acceptance of internet banking in Estonia†, International Journal of Bank Marketing,Vol.23 No. 2, pp. 200-216. Freiden, J.B. (1984), â€Å"Advertising spokesperson effects: an examination of endorser type and gender on two audiences†, Journal of Advertising Research, Vol. 24 No. 5, pp. 33-41. Haghirian, P. and Madlberger, M. (2005), â€Å"Consumer attitude toward advertising via mobile devices an empirical investigation among Austrian users†, in Proceedings of the European Conference on Information Systems, Regensburg, Germany, May 2005, (accessed on 4/26/2006). Hair, J.F., Anderson, R.E., Tatham, R.L. and Black, W.C. (1998), â€Å"Multivariate Data Analysis†, 5th Ed., Prentice-Hall, Englewood Cliffs, NJ. Hu, L.-T. and Bentler, P. (1999), â€Å"Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives†, Structural Equation Modeling, Vol. 6 No. 1, pp. 1-55. Kaikati.J.G. (1987),â€Å"Celebrity advertising, a review and synthesis†, International Journal of Advertising, 6.93-105. Kamins, M.A. (1990), â€Å"An investigation into the ‘match-up’ hypothesis in celebrity advertising: when beauty may be only skin deep†, Journal of Advertising, Vol. 19 No. 1, pp. 413. Lear,K.E, Runyan,R.C. and Whitaker,W.H. (2009), â€Å"Sports celebrity endorsements in retail products adver tising†, International Journal of Retail Distribution Management, Vol. 37 No. 4, pp. 308-321. Katyal, S. (2008), â€Å"Impact of Celebrity Endorsement on a Brand†, Chillibreeze writer, available at www.chillibreeze.com/articles/ accessed on 12th, July. Khatri, P. (2006), â€Å"Celebrity Endorsement: A Strategic Promotion Perspective†, Indian Media Studies Journal Vol.1 No.1. July-Dec. 405

Posterior Reversible Encephalopathy (PRES)

Posterior Reversible Encephalopathy (PRES) Posterior Reversible Encephalopathy (PRES): A Rare Presenting Feature of Pheochromocytoma Abstract Hypertension in young is mostly due to secondary causes and one of them is pheochromocytoma. These are catecholamine secreting enterochromaffin tumors causing paroxysmal hypertension. Adrenal pheochromocytoma presenting as posterior reversible encephalopathy syndrome (PRES) is very rare and has not been described in literature so far. Here, we report a case of previously healthy adolescent boy, who presented with acute onset severe headache, blurring of vision, generalized tonic clonic motor seizure and altered sensorium. His blood pressure was 234/126 mm Hg. The magnetic resonance imaging (MRI) of brain showed hyperintense signal on T2-weighted and fluid attenuated inversion recovery (FLAIR) images in bilateral parietal and occipital regions. High blood pressure and classical MRI findings were consistent with the diagnosis of PRES. Abdominal ultrasonography (USG) revealed a right adrenal mass. A diagnosis of pheochromocytoma was confirmed by abdominal triple phase contrast- computed tomography (CT) and 24-hour urinary metanephrine assay. After the blood pressure was stabilized with alpha and beta blockade, adrenal tumor was surgically excised. Histopathologic examination of tissue confirmed the diagnosis of pheochromocytoma. The MRI brain showed complete resolution of hyperintense signals (T2-weighted and FLAIR images) on two-months follow-up. He was symptom free at six months and one year follow-up. Key words: Posterior reversible encephalopathy syndrome (PRES); Reversible posterior leukoencephalopathy (RPLE); Pheochromocytoma; Hypertensive Encephalopathy; Hypertension Abbreviations: ADC: apparent diffusion coefficient; CT: computed tomography; MRI: magnetic resonance imaging; DWI: diffusion-weighted imaging; PRES: posterior reversible encephalopathy syndrome Introduction Hypertension in young is mostly due to secondary causes which include renal diseases (chronic renal failure, renal artery stenosis, polycystic kidney disease), coarctation of the aorta, systemic lupus erythematosus (SLE) and endocrinopathies. Pheochromocytomas are rare catecholamine secreting enterochromaffin tumors. The patients of pheochromocytoma usually present with spells of headache, sweating and palpitations due to excessive catecholamines. The cerebral manifestation of pheochromocytoma are uncommon. Posterior reversible encephalopathy syndrome (PRES) as a presenting feature of pheochromocytoma is rare. Case Report A 14-year-old previously healthy boy presented in emergency department with acute onset severe holocranial headache, blurring of vision, generalized tonic clonic motor seizure followed by altered sensorium. There was no previous history of nausea, vomiting, diarrhea, flushing, excessive sweating, migraine, autoimmune and connective tissue disorders, drug abuse, toxin exposure, hypertension or diabetes mellitus. He had no similar illness in past and family history was negative. His pulse rate and blood pressure were 130 beats per minute and 234/126 mm Hg, respectively. He was confused but followed simple commands. The pupillary size and light reaction were normal on both sides. Fundus examination showed bilateral papilledema. He was moving all the four limbs equally without asymmetry on painful stimulus. Plantars were bilaterally extensor. Signs of meningeal irritation (neck rigidity and Kernigs signs) were negative. Complete hemogram, serum electrolyte, renal function tests and other biochemistry including thyroid function tests were normal. Serum anti-nuclear antibodies (ANA), anti-double-stranded DNA antibody (anti-dsDNA) and ELISA test for human immunodeficiency virus (HIV) were negative. X-ray chest was normal. Electrocardiography (ECG) showed tachycardia. Magnetic resonance imaging (MRI) of brain showed hyperintense signal changes on T2-weighted and fluid attenuated inversion recovery (FLAIR) images in bilateral occipito-parietal regions. No restriction was seen on diffusion-weighted images (DWI) [Figure 1]. CT angiography of brain vessels was normal. High blood pressure and classical MRI findings were consistent with the diagnosis of PRES. On further evaluation, abdominal ultrasonography (USG) showed right adrenal mass. An abdominal triple phase contrast-enhanced CT scan revealed heterogeneous, contrast enhancing adrenal gland mass lesion measuring 32 x 26 mm suggestive of pheochromocytoma [Figure 2]. The diagnosis was confirmed by 24-hour urinary metanephrine assay. The plasma aldosterone concentration (PAC) and plasma renin activity (PRA) ratio (PAC/PRA) was 10.4. The 24- hour urinary normetanephrine was 31,572 Â µg/24 hour (normal: 63-402 Â µg/24 hour), urinary metanephrine was 1,524 Â µg/24 hour (normal: 32-167 Â µg/24 hour) and plasma noradrenaline level was 18,635 pg/mL (normal: 0-400 pg/mL). Patient was managed intensively with nitroprusside infusion to reduce blood pressure. Injectable phenytoin was administered according to body weight to control seizures. Once patient was stabilized, he was started on oral alpha-blocker prazosin (20 mg/day) followed by beta-blocker propranolol (40 mg/day). After adequate alpha and beta blockade, patient was planned for surgery and resection of adrenal mass was done. Histopathologic examination confirmed the diagnosis of pheochromocytoma without invasion of the adrenal capsule [Figure-3]. The MRI brain showed complete resolution of hyperintense signals (T2-weighted and FLAIR images) and 24-hour urine metanephrines were normal on two-months follow-up. He was asymptomatic at six months and one year follow-up. Discussion Pheochromocytomas are neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. The classical features like holocranial headache, palpitations, hypertension, hyperhidrosis, hyperglycemia and hypermetabolism are due to excessive catecholamines production in these tumors. The cardiac complications such as arrhythmias, myocardial infarction and sudden deaths are associated with cardiotoxic effects of high blood catecholamines levels. Pheochromocytoma is a rare cause of secondary hypertension and accounts for 0.5% to 2.0% of all causes of hypertension in children. The neurological complications (ischemic or hemorrhagic stroke) are related to increased platelet aggregation, hypertension and vasospasm due to high catecholamines levels. The various potential triggers of pheochromocytoma crisis leading to hemodynamic instability are stress, blood loss, surgery and anesthesia. The diagnosis of pheochromocytoma is confirmed by 24-hour urinary meta nephrine and normetanephrine levels. Clinical features of reversible posterior leukoencephalopathy syndrome (PRES) are acute onset headaches, vision loss, seizures and altered sensorium. It is mostly due to hypertension, however other common causes are chronic renal disease, uremic encephalopathy, ergot alkaloids, steroids, chemotherapy, vasculitis and tumors. Pheochromocytoma is one of the rare cause of PRES due to secondary hypertension. However, to the best of our knowledge, acute, life-threatening initial presentation of pheochromocytoma as PRES has not been described in literature. Magnetic resonance images (MRI) of brain typically shows hyperintense signal changes on T2-weighted and fluid attenuated inversion recovery (FLAIR) images due to vasogenic edema. It mostly involves the cortical and subcortical white matter of the parietooccipital, frontal and temporal regions. Cerebral hemorrhage, cytotoxic edema and contrast enhancement are atypical imaging findings of PRES. The parietooccipital cortex and subcortical w hite matter were affected in our case. Classically, these signal abnormalities are reversible on antihypertensive therapy. The pathophysiology of PRES is still poorly understood, however, various hypothesis have been proposed. Severe hypertension causes deranged autoregulation of sympathetically mediated cerebral arterioles. It leads to increased permeability in the blood-brain barrier and causes vasogenic edema. Sympathetic innervation of the vertebrobasilar system is not as extensive or as complete as that of the anterior circulation. Therefore, PRES predominantly affects parietooccipital cortex and subcortical white matter. Other possible mechanism may be endothelial dysfunction due to circulating toxins or chemotherapy agents. There may be cerebral infarction or hemorrhage due to compromise of the microcirculation by pressure from surrounding vasogenic edema. The exact etiology of the seizure remains unknown, but may result from effects of the pheochromocytoma on reducing seizure threshold via its actions on metabolic or hypertensive parameters. Our patient had high levels of circulating catecholamin es, produced autonomously by tumor. Once vasogenic edema subsided with antihypertensive therapy, all the abnormal MRI findings vanished. Clinical topography (acute onset headache, visual blurring, seizure and altered sensorium), high blood pressure and typical MRI findings suggested diagnosis of PRES. In our patient, other differential diagnosis such as thrombocytopenic thrombotic purpura (TTP), hemolytic uremic syndrome (HUS), encephalitis, systemic lupus erythematosus (SLE), brain mass lesions and drug toxicity were ruled out by appropriate clinical and laboratory investigations. In our patient, hypertension was detected for the first time on hospital admission and before that he never had any symptoms like headache, palpitations, perspiration or diarrhea. Our patient is of clinical interest as pheochromocytoma presented with life-threatening hypertensive encephalopathy. Management of pheochromocytoma requires aggressive approach including fluid resuscitation and antihypertensive therapy (both alpha and beta blockade) followed by surgical resection of tumor. Conclusion Pheochromocytomas are catecholamine secreting enterochromaffin tumors causing paroxysmal hypertension. Our patient is of clinical interest as an acute, life-threatening hypertensive encephalopathy (PRES) as a presenting feature of adrenal pheochromocytoma has not been described in literature so far. Pheochromocytoma should be ruled out in every young patient with acute hypertensive encephalopathy. Figure Legends Figure 1. Magnetic resonance imaging (MRI) of brain showing hyperintense signals on T2-weighted and fluid-attenuated inversion recovery (FLAIR) images in parieto-occipital region. No diffusion restriction is seen. [ T1-weighted axial (A), T2-weighted axial and sagittal (B,C), FLAIR (D), diffusion weighted (DWI) (E) and corresponding apparent diffusion coefficient (ADC) (F) images]. These abnormal signals completely vanished on follow-up MRI after six weeks. Figure 2. Triple phase contrast-enhanced computed tomography (CT) of abdomen showing heterogenous enhancing mass lesion measuring 32 x 26 mm in right adrenal gland. [Axial CT: Arterial phase (A,B), Venous phase (C) and Delayed phase (D)]. Figure 3. Hematoxylin and eosin (HE) stained microphotographs showing large pleomorphic nuclei, abundant basophilic cytoplasm and cell-nesting pattern (zellballen pattern). [HE stain 40x view (A), 100x view (B,C)]. 1

Aspects of Breast Cancer :: essays papers

Aspects of Breast Cancer According to the American Cancer Society, in the United States in 1997 alone, 180,000 people were diagnosed with a horrible disease. Of all types of cancer breast cancer ranks second and is the number one cancer which is fatal in women between ages of 15 to 54. This cancer is within the top three cancers of all women above the age of 15. This awful disease is breast cancer. Breast cancer is a group of rapidly growing reproducing, undifferentiated cells in the area of the breast in a woman. The earliest stages occur in the epithelial cells of the terminal end buds (TEB) of the breast milk ductal system. While the causes of breast cancer are unknown, the cells in the breast trigger a reaction of cell reproduction. These new cancer cells form tumors. If cancer cells are active or are considered malignate, the tumor grows at tremendous speeds, and may end up in metastasis. Metastasis is a process in which cells break away from their primary tumors and is carried through the blood supply or through the lymph system and relocate into other organs, thus spreading cancer throughout the body if left untreated. Generally, if a lump is less than one centimeter, it is considered benign, although every woman should consult her doctor about any unusual bumps or feeling in the chest. One sign of breast cancer results from ductal cancer in the breast. A once hollow open tube could be completely clogged up with cancerous cells thus leaving an awkward feeling in the chest area. The body is forced to supply nutrition for itself, but also for the large tumors that clog and cram the system. Although there are many different types of breast cancer, these are the most common. The first one is adenocarcinoma. It starts in the glandular tissues in any part of the body. Even though that it is a commonly diagnosed cancer the prognosis can vary greatly due to when the cancer is found. This accounts for nearly all breast cancer. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer. It starts in ducts but doesn^Ã’t spread through the duct walls. The best way to detect this kind of cancer is by a mammogram. This may change into an invasive cancer if not caught in time. If it changes then it is called an infiltrating ductal carcinoma (IDC). This form of invasive cancer invades the fatty tissue of the breast. IDC invades to other parts of Aspects of Breast Cancer :: essays papers Aspects of Breast Cancer According to the American Cancer Society, in the United States in 1997 alone, 180,000 people were diagnosed with a horrible disease. Of all types of cancer breast cancer ranks second and is the number one cancer which is fatal in women between ages of 15 to 54. This cancer is within the top three cancers of all women above the age of 15. This awful disease is breast cancer. Breast cancer is a group of rapidly growing reproducing, undifferentiated cells in the area of the breast in a woman. The earliest stages occur in the epithelial cells of the terminal end buds (TEB) of the breast milk ductal system. While the causes of breast cancer are unknown, the cells in the breast trigger a reaction of cell reproduction. These new cancer cells form tumors. If cancer cells are active or are considered malignate, the tumor grows at tremendous speeds, and may end up in metastasis. Metastasis is a process in which cells break away from their primary tumors and is carried through the blood supply or through the lymph system and relocate into other organs, thus spreading cancer throughout the body if left untreated. Generally, if a lump is less than one centimeter, it is considered benign, although every woman should consult her doctor about any unusual bumps or feeling in the chest. One sign of breast cancer results from ductal cancer in the breast. A once hollow open tube could be completely clogged up with cancerous cells thus leaving an awkward feeling in the chest area. The body is forced to supply nutrition for itself, but also for the large tumors that clog and cram the system. Although there are many different types of breast cancer, these are the most common. The first one is adenocarcinoma. It starts in the glandular tissues in any part of the body. Even though that it is a commonly diagnosed cancer the prognosis can vary greatly due to when the cancer is found. This accounts for nearly all breast cancer. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer. It starts in ducts but doesn^Ã’t spread through the duct walls. The best way to detect this kind of cancer is by a mammogram. This may change into an invasive cancer if not caught in time. If it changes then it is called an infiltrating ductal carcinoma (IDC). This form of invasive cancer invades the fatty tissue of the breast. IDC invades to other parts of

Jealousy in Ancient Greek Society :: Greek History Studies

Jealousy in Ancient Greek Society Jealousy is one of the harsher and more passionate faces of Love in Ancient Greek Society. Societal norms for love and relationships dictate that older men are the lovers who pursue women and young boys. Love infects the pursuer and causes him to have intense feelings about the object of his desire, but not always vice versa. Consequently jealousy is seen more as the active partner’s disease and is commonly associated as a male emotion. Women also experience jealousy but they are not supposed to be the pursuers in relationships according to societal norms. Since society only excuses the pursuer in the relationship acting on jealous impulses, a women doing so was improper because she was not supposed to be the active partner in the relationship. Hence jealousy was much more widely accepted as a ‘man’s’ disease. By examining the views of society in The Women of Trachis and the Legal Text VIII, Wounding with Intent to Kill: Quarrel over a boy, on love as a sickness, controlling jealousy, and how to win back a lost love, we can conclude that Love’s face of jealousy in Ancient Greek society appears to only be accepted as a predominately male emotion. Society excuses many of men’s jealous and irrational actions because of the widely held belief that Love effects men like a sickness. In The Women of Trachis, Deianira continually excuses her husbands actions, blaming his outrageous deeds on him being poisoned by Love. When Heracles attacked a city so that he could win his mistress, Deianira blames Love for rousing him to such violence. She thinks that it is "love alone which bewitched him into this violence"(355). She has also justified all his past affairs with this same theory. Deianira mentions that Heracles "is sick as he so often is with this same sickness"(543) of love. Society has allowed men to use Love as an excuse for their outrageous actions as well as the legitimate reasoning behind their deeds. Deianira also expresses society's view on Love’s power when she says, "For [Love] rules even the gods as he pleases"(443).

Developing nursing standards of practice Essay

The standards of practice for the RN are made up by the state board of nursing that the nurse lives in. It is each nurse’s responsibility to know and abide by their standards of practice for their state. Each state develops their standards of practice by following guidelines that the American Nurses Association (ANA) provides. The ANA has a committee on Nursing Practice Standards and Guidelines that has a duty to clarify the role and relationships that are associated with regulation of all nursing practice (ANA, n.d.). â€Å"The model recognizes the contributions of professional and specialty nursing organizations, educational institutions, credentialing and accrediting organizations, and regulatory agencies; clarifies the role of workplace policies and procedures; and confirms the individual nurse’s ultimate responsibility and accountability for defining nursing practice† (ANA, n.d.). There are 5 essential entities that are involved with developing a standard of practice. They are knowledge, role validation, competence and skill, environment, and ethics (Klein, 2005). As a standard of practice is being developed, there are questions for each entity that can be asked. For example: Knowledge—â€Å"Did I complete a program that prepared me to see this population (family, adult, pediatric) of patients?† (Klein, 2005) Role Validation—â€Å"Is additional licensure or certification required to do this skill on an ongoing or specialized basis?† (Klein, 2005) Competence and Skill—â€Å"How have I maintained competence?† (Klein, 2005) Enviroment—â€Å"Does the environment that I work in support this scope or practice through structures such as staffing, consultation, policies and procedures, protocols, and community standards?† (Klein, 2005) Ethics—â€Å"What are the potential consequences of accepting treatment responsibility for this patient?† (Klein, 2005) In conclusion, the board of nursing wants the practicing nurse to be fully competent in their work. This is a direction of how they determine the standards of practice that we follow. American Nurses Association. Determining Scope of Practice for Advanced Practice Registered Nurses.Retrieved August 6, 2014, from http://www.nursingworld.org/ScopeofPractice Klein, T. A. (2005). Scope of Practice and the Nurse Practitioner: Regulation, Competency, Expansion and Evolution. 1-2.